ABSTRACT
BACKGROUND: Despite widespread clinical use of cryogen spray cooling (CSC) in conjunction with laser dermatologic surgery, in vivo cutaneous effects have not been systematically evaluated. OBJECTIVE: The authors characterize the in vivo cutaneous effects for Fitzpatrick skin types I through VI after CSC exposures of varying spurt durations and spurt delivery patterns (single vs. multiple spurts). MATERIALS AND METHODS: Twenty-seven normal human subjects were exposed to single cryogen spurts from 10 to 80 milliseconds, and multiple spurt patterns consisting of two 20-millisecond spurts, four 10-millisecond spurts, and eight 5-millisecond spurts. Subjects were evaluated by clinical observation and photography at 1 hour, 1 day, and 1, 4, 8, and 12 weeks after CSC exposure. RESULTS: Acute erythema and urticaria (1-24 hours) were noted in 14 of 27 and 3 of 27 subjects, respectively. Transient hyperpigmentation occurred in 4 of 27 subjects (skin types III-VI) but resolved spontaneously without medical intervention in all subjects by 8 weeks. No permanent skin changes were noted in any subjects. Skin reactions were more common with longer single-spurt durations (50 milliseconds or greater) and multiple spurt patterns. CONCLUSION: Acute erythema, urticaria, and, less commonly, transient hyperpigmentation were observed after CSC exposure. Permanent skin injury was not observed and is unlikely.
Subject(s)
Cryotherapy/methods , Low-Level Light Therapy , Skin/injuries , Administration, Topical , Aerosols/administration & dosage , Aerosols/pharmacology , Cryotherapy/adverse effects , Fluorocarbons/administration & dosage , Fluorocarbons/pharmacology , Humans , Skin/radiation effects , Skin Pigmentation/radiation effectsABSTRACT
BACKGROUND AND OBJECTIVE: To determine the efficacy and safety of the ThermaCool TC radiofrequency system for treatment of hypertrophic and keloid scars and evaluate treatment associated collagen changes. MATERIALS AND METHODS: Six subjects with hypertrophic and four with keloid scars were treated with the ThermaCool device: one-third of the scar received no treatment (control), one-third received one treatment and one-third received two treatments (4-week interval). Scars were graded before and then 12 and 24 weeks after treatment on symptoms, pigmentation, vascularity, pliability, and height. Biopsies were taken from four subjects with hypertrophic scars and evaluated with hematoxylin and eosin (H & E) staining, multiphoton microscopy, and pro-collagen I and III immunohistochemistry. RESULTS: No adverse treatment effects occurred. Clinical and H & E evaluation revealed no significant differences between control and treatment sites. Differences in collagen morphology were detected in some subjects. Increased collagen production (type III > type I) was observed, appeared to peak between 6 and 10 weeks post-treatment and had not returned to baseline even after 12 weeks. CONCLUSION: Use of the thermage radiofrequency device on hypertrophic scars resulted in collagen fibril morphology and production changes. ThermaCool alone did not achieve clinical hypertrophic scar or keloid improvement. The collagen effects of this device should be evaluated further in order to optimize its therapeutic potential for all indications.
Subject(s)
Catheter Ablation/instrumentation , Cicatrix, Hypertrophic/pathology , Cicatrix, Hypertrophic/surgery , Keloid/pathology , Keloid/surgery , Adult , Aged , Biopsy, Needle , Catheter Ablation/methods , Collagen/radiation effects , Equipment Design , Equipment Safety , Female , Follow-Up Studies , Humans , Immunohistochemistry , Male , Middle Aged , Reference Values , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
The use of botulinum toxin A in cosmetic dermatology has increased in popularity due to the efficacy and relative safety of the treatment. Botulinum toxin A is one of eight exotoxins produced by Clostridium botulinum, a Gram-positive, spore-forming anaerobe. Flaccid paralysis results from the denervation of muscle fibers at the neuromuscular junction after botulinum toxin A administration. While treating blepharospasm, the Carruthers incidentally found that botulinum toxin A improved glabellar frown lines. Dynamic rhytides occur in areas of dynamic motion. These types of lines may be improved with botulinum toxin A. There are two types of botulinum toxin A commercially available (BOTOX and Dysport); only BOTOX is currently available in the US. The efficacy and tolerability of BOTOX was best demonstrated with a multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines in 264 patients. There was a significantly greater reduction in glabellar line severity with BOTOX. The effect was maintained for the duration of the study (120 days). There was low occurrence (5.4%) of mostly mild blepharoptosis in the BOTOX group. In another prospective study, it was found that about 1% of BOTOX patients reported severe headache. Botulinum toxin A can provide an alternative treatment of palmar and axillary hyperhidrosis when options such as topical agents (aluminum chloride) and iontophoresis have failed.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Hyperhidrosis/drug therapy , Neuromuscular Agents/administration & dosage , Skin Aging , Dermatology , Eye , Forehead , Humans , Mouth , Randomized Controlled Trials as Topic , Surgery, PlasticABSTRACT
Seborrheic dermatitis is generally treated with topical steroids, antifungals, or both. This pilot study was undertaken to examine the possibility of tacrolimus as a useful therapy for seborrheic dermatitis. In a single-center, open-label study, 18 consecutive patients with seborrheic dermatitis were treated with 0.1% tacrolimus for a total of 28 days or until complete clearance occurred, if sooner. Of the patients, 11 (61%) showed 100% clearance of their seborrheic dermatitis; the remaining 7 patients showed 70% to 99% clearance. The most common side effects were mild local burning and irritation.
